“Nov. 4. The leeches were repeated; much the same. “8. Symptoms as before. As he complains of pain over the eyebrow, with nausea, let the mercury be left off. A variety of constitutional and local treatment has been pursued during Mr. Liston’s absence from the hospital, but without affording any relief; the patient’s nights were passed in great agony, and his general health began to suffer. On the 27th, after consultation with Mr. Fisher, the surgeon to the Police Force, Mr. Liston had the patient carried into the operating theatre. He made an incision along the spine of the tibia of about three inches in extent; another shorter one was made to fall on this at right angles from the inner side. The surface of the bone thus exposed was perforated to the depth of fully half an inch by a small trephine. A very dense circle was removed from the perforation; still the fluid, which was suspected to exist, did not appear. Mr. Liston, encouraged by the intense pain complained of as the process of perforation proceeded, again applied the crown of the instrument, and after a few more turns, brought out a further circle of considerable thickness, and this was forthwith followed by a flow of well-digested purulent matter. [Illustration] “28. Complains of no pain comparatively; slept well last night after an anodyne draught; has felt much relieved since the operation; a good deal of matter was discharged from the sore during the night; water-dressing to be applied to the wound. “30. Slept well without any anodyne the last two nights. The relief afforded by the operation is felt more now than it was at first. The wound discharges a good deal. A tonic mixture, containing infusion of gentian, sulphate of magnesia, and sulphuric acid, was ordered. “Dec. 2. The wound looks florid and clean; granulations are springing up; general health very much improved. “4. The edges of the wound are thickened by the granulations; the discharge from the wound still considerable; feels quite well in health. “12. The wound continues much the same; the rollers have been discontinued. “14. Feels himself gaining strength daily; can walk without pain; wound is contracting and hard; granulations seem to lessen the depth of the opening in the bone; there appears to be no sequestrum.” When caries is fairly established, and the integuments have given way, the best and most successful proceeding is that pointed out by nature—destruction of the diseased portion; and the means must vary according to the particular circumstances. In many cases, nature seems to wait but for the separation of the sickly parts, either by accident, or by the interference of art. The means are to remove, partially or wholly, the diseased part, or to effect such a change of action as will throw it off. The first indication will be accomplished by trephines, scoops, saws, and forceps; the second by active escharotics; frequently both are required.